Provider Demographics
NPI:1730105362
Name:DUFF-BOEHM, NANCY (PHD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DUFF-BOEHM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26777 LORAIN RD
Mailing Address - Street 2:SUITE 716
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3200
Mailing Address - Country:US
Mailing Address - Phone:440-777-9200
Mailing Address - Fax:440-777-9288
Practice Address - Street 1:26777 LORAIN RD
Practice Address - Street 2:SUITE 716
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3200
Practice Address - Country:US
Practice Address - Phone:440-777-9200
Practice Address - Fax:440-777-9288
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3637103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000293193OtherANTHEM
OH0238684Medicaid
OH680011568OtherRAILROAD MEDICARE
OH0238684Medicaid
OHCP14118Medicare PIN